Healthcare Provider Details

I. General information

NPI: 1093060238
Provider Name (Legal Business Name): RENE SALHAB MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 MILLIKEN AVE STE 201
RANCHO CUCAMONGA CA
91730
US

IV. Provider business mailing address

8112 MILLIKEN AVE STE 201
RANCHO CUCAMONGA CA
91730-7473
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-7337
  • Fax: 909-466-7338
Mailing address:
  • Phone: 909-466-7337
  • Fax: 909-466-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA110333
License Number StateCA

VIII. Authorized Official

Name: DR. RENE SALHAB
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 909-466-7337